Introduction to Psychoanalysis The psychoanalytic movement has expanded and diversified in many directions over its one hundred year history. Introduction to Psychoanalysis: Contemporary Theory and Practice examines the contributions made by the various schools of thought, explaining the similarities and differences between Contemporary Freudian, Independent, Kleinian, Object Relations, Interpersonal, Self Psychological and Lacanian analysis. The authors address crucial questions about the role of psychoanalysis in psychiatry and look ahead to the future. The book is divided into two parts covering theory and practice. The first part considers theories of psychological development, transference and countertransference, dreams, defence mechanisms, and the various models of the mind. The second part is a practical introduction to psychoanalytic technique with specific chapters on psychoanalytic research and the application of psychoanalytic ideas and methods to treating psychiatric illness. Well referenced and illustrated throughout with vivid clinical examples, this will be an invaluable text for undergraduate and postgraduate courses in psychoanalysis and psychoanaltytic psychotherapy, and an excellent source of reference for students and professionals in psychiatry, psychology, social work, and mental health nursing. Anthony Bateman is Consultant Psychotherapist, St Ann’s Hospital, London and a member of the British Psychoanalytical Society. Jeremy Holmes is Consultant Psychotherapist and Psychiatrist, North Devon. Introduction to Psychoanalysis Contemporary theory and practice Anthony Bateman and Jeremy Holmes London and New York First published 1995 by Routledge 11 New Fetter Lane, London EC4P 4EE Simultaneously published in the USA and Canada by Routledge 29 West 35th Street, New York, NY 10001 Routledge is an imprint of the Taylor & Francis Group This edition published in the Taylor & Francis e-Library, 2001. © 1995 Anthony Bateman and Jeremy Holmes All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloguing in Publication Data Bateman, Anthony Introduction to psychoanalysis: contemporary theory and practice/Anthony Bateman and Jeremy Holmes. p. cm. Includes bibliographical references and index. 1. Psychoanalysis. I. Holmes, Jeremy. II. Title. [DNLM: 1. Psychoanalysis. 2. Psychoanalytic Theory. 3. Psychoanalytic Therapy. WM 460 B328i 1995] RC504.B295 1995 616.89´17–dc20 DNLM/DLC for Library of Congress 95–7617 CIP ISBN 0–415–10738–5 (hbk) ISBN 0–415–10739–3 (pbk) ISBN 0-203-13305-6 Master e-book ISBN ISBN 0-203-17610-3 (Glassbook Format) Contents Preface vii Acknowledgements xi Part I: Theory 1 Introduction: history and controversy 3 2 Models of the mind 27 3 Origins of the internal world 49 4 Mechanisms of defence 76 5 Transference and Countertransference 95 6 Dreams, symbols, imagination 118 Part II: Practice 7 The assessment interview 139 8 The therapeutic relationship 153 9 Clinical dilemmas 182 10 Psychoanalytic contributions to psychiatry 212 11 Research in psychoanalysis 243 References 260 Index 283 Preface Newcomers to psychoanalysis, especially if they wish to avoid confusion, are usually best advised to go straight to Freud – to the lectures on technique (Freud 1912a, b; 1914a), the Introductory Lectures (Freud 1916/ 17), or the two encyclopedia articles (Freud 1922). This is not just because Freud is the fount from which psychoanalysis has flowed, or because of the clarity of his thought and style, or even because ‘going back to Freud’ remains a psychoanalytic imperative. It is also because in the early years a single psychoanalytic ‘mastertext’ (Schafer 1990) was still possible, in a way that has become increasingly problematic as the psychoanalytic movement has both expanded and diversified, but also been challenged by controversy and schism. There are many excellent introductory or semi-introductory contemporary books about the practice of psychoanalysis. Those that we have found especially useful are starred in the bibliography. Each tends to present a particular perspective on the psychoanalytic process: Kleinian, Independent, Contemporary Freudian, Interpersonal, Kohutian, Lacanian, Ego Psychological. This is partly an inevitable result of the unique centrality of personal analysis in analytic training. Each of the differing psychoanalytic approaches represents not just a theoretical orientation, but a tradition, style, affiliation, and set of common values and assumptions that the analysand will acquire in the course of this training. He or she has to undergo the maturational task of both assimilating all that has been identified with, and at the same time achieving the inner freedom needed to find his or her own analytic voice. When we were invited by Edwina Welham of Routledge, at Jonathan Pedder’s suggestion, to write a companion volume to the Introduction to viii Preface Psychotherapy (Brown and Pedder 1993), we felt that the time was ripe for an attempt to bring together the varying strands of psychoanalytic theory and practice, to highlight their ‘common ground’ (Wallerstein 1992) as well as their differences. We were encouraged by the idea that despite theoretical divergence, ‘clinical theory’ (G. Klein 1976) can be unified in a meaningful way. We were determined to anchor our text with many clinical examples, and to try to show how a variety of clinical approaches fit within a common framework. We are aware of the dangers and pitfalls of both sectarianism and eclecticism. Analysts need to be able to draw on the range of different ideas and techniques that are encompassed within the diversity of their profession. At the same time, in order to practise effectively, most need to work within a particular analytic perspective. Our book is perhaps in the ‘critical dictionary’ (Rycroft 1972; Hinshelwood 1989) tradition in that it tries to clarify, question and extract what is valuable from each psychoanalytic viewpoint. Wherever possible, we have brought research findings to bear on psychoanalytic concepts and practice, and, within the limitations of the lag between composition and publication, to be as up-to-date as possible with contemporary psychoanalytic thought. We have subtitled our book ‘contemporary theory and practice’, drawing a useful, but none the less somewhat artificial, contrast between ‘classical’ and ‘modern’ (or ‘contemporary’) practice and thought. ‘Classical’ and ‘modern’, while useful as a shorthand, should not be thought of as oppositional, but rather the one resting on the other. Also, since we work both simultaneously within a public sector psychiatric context as well as private practice, we have angled a fair proportion of what we discuss towards the role of psychoanalytic therapy with quite disturbed patients. That raises the issues of who we, the authors are. One of us (AB) is an analyst with considerable psychiatric experience, the other (JH) also a psychiatrist and psychotherapist with psychoanalytic leanings. We hope that as a team we have enough in common to provide a unified view, and enough difference to add breadth to our exposition. On the whole our collaboration has run smoothly. On occasions one of us has felt that we have been too critical and not ‘analytic’ enough; the other that we were being too reverential and have failed to locate the analytic approach within a wider context. And what of you, the reader? Our hope was to produce a book that would be useful for students of psychoanalysis and psychoanalytic psychotherapy looking for a single volume that would encompass the Preface ix main principles and practice of contemporary psychoanalysis, be clinically relevant, and theoretically stimulating. For some, no doubt, much of what we say will be familiar, for others obscure. We hope we have created sufficient transitional space between innocence and experience to be of value. We are only too aware of the many faults of omission and commission in the book. We have tackled the issues of ethnicity, class and gender in only a very limited way. Apropos of the latter, like many contemporary authors we have been stymied by the problem of pronouns, but, in the end, reluctantly have stayed with the less obtrusive, but patriarchal ‘he’, despite the fact that statistically, female analysts and patients probably outnumber males. Our psychoanalytic approach is almost exclusively ‘Freudian’, and we have undoubtedly failed to do justice to the scope of Jungian psychoanalysis. Another notable omission is any serious consideration of child psychoanalysis, which is outwith both our competences. Lacking space rather than enthusiasm, we have failed to follow the important cultural ramifications of psychoanalysis into the fields of literary theory, psychohistory and sociology. The text is illustrated with many examples. We are deeply aware of the ethical difficulties in using case material in print. In some instances we have asked our patients for permission to publish such material. In others this has not been possible, but we have in every case disguised and fictionalised biographical details. Books should not necessarily be read from start to finish. Each chapter is complete